Clinical

Before chemo, screen for HBV and treat it prophylactically: study

Last Updated: 2011-11-17 18:25:14 -0400 (Reuters Health)

By Rob Goodier

NEW YORK (Reuters Health) - Screening high-risk patients for hepatitis B virus infection before chemotherapy - and treating it prophylactically -- can drastically reduce mortality if the virus reactivates, new data show.

In the study, nearly a quarter of cancer patients with hepatitis B surface antigen (HBsAg) or hepatitis B core antibodies (anti-HBc) had reactivation of the virus as a result of chemotherapy.

And among those patients, the mortality rate was 22% when antivirals were started prior to chemotherapy but 72% when antiviral treatment didn't start until reactivation was recognized, the researchers say.

"I hope my study results will increase awareness among medical providers so that they will actively screen for hepatitis B viral infection to prevent poor outcomes for these patients after their chemotherapy," Dr. Jessica Hwang, who led the study at the MD Anderson Cancer Center in Houston, Texas, told Reuters Health by email.

Dr. Hwang presented her results November 7th at the American Association for the Study of Liver Diseases' annual meeting in San Francisco.

She and her colleagues reviewed medical records on 10,729 chemotherapy patients treated at their hospital and found that less than one in five (1,787, or 17%) had been screened in advance for hepatitis B. Tests were positive in 151 (8%).

The virus reactivated in 34 patients, representing 23% of those who tested positive and 2% of all patients screened.

Only nine of the 34 patients (26%) had started taking antiviral drugs prophylactically before chemotherapy. Another 11 (32%) began antiviral treatment after the fact. Those who were not treated for hepatitis at all had a 71% all-cause mortality rate, similar to the rate in the patients who started antiviral therapy after reactivation.

In her abstract for the meeting, Dr. Hwang wrote that not screening at-risk patients for hepatitis B before chemotherapy is "resulting in preventable reactivation."